Wednesday, April 14, 2021

Solomon Center Hosts Panel on Access to Insulin

On March 9, 2021, the Solomon Center for Health Law and Policy hosted a virtual panel discussion on the history and accessibility of insulin. The event was co-sponsored by Yale University’s Program in the History of Science and Medicine and featured experts in history, law, medicine, and public health.

The panel, “100th Anniversary of Insulin’s Discovery: Diabetes Should Not Be A Death Sentence,” featured David Beran, Researcher and Lecturer at the Geneva University Hospitals and the University of Geneva; Dr. Aaron S. Kesselheim, Professor of Medicine at Harvard Medical School, Sidley Austin-Robert D. McLean Visiting Professor in Law at Yale Law School, and Distinguished Visitor at the Solomon Center for Health Law and Policy; Daniel Kevles, Stanley Woodward Professor Emeritus of History, History of Medicine, & American Studies at Yale University and Adjunct Professor at Yale Law School; and Dr. Kasia Lipska, Associate Professor of Medicine at Yale School of Medicine.

Ryan Knox, Senior Research Fellow at the Solomon Center for Health Law and Policy, organized and moderated the panel discussion. Dr. Laura Nally, Pediatric Endocrinologist and Clinician Scholar at Yale School of Medicine, and Arleen Tuchman, Nelson O. Tyrone Jr. Chair in History at Vanderbilt University, joined as invited commentators.

Kevles opened the discussion with a history of insulin’s discovery — first with insulin being isolated from animal pancreases in Toronto, Canada in 1921 and later with the development of recombinant human insulin by Genentech in the 1970s. The panelists addressed how, although the initial scientists who discovered insulin sold their patent rights with the goal of promoting access for all, Genentech and other companies profited immensely from their insulin innovations.

Panelists then discussed the reasons for insulin’s high prices — from limited competition to regulatory barriers to intellectual property. Beran explained how the global insulin market is dominated by three major companies — Novo Nordisk, Sanofi, and Eli Lilly, sometimes called the “Big Three” — that have largely prevented the entry of biosimilar competitors. Kesselheim said that although the major patents on the insulin molecules have expired, related device patents and Food and Drug Administration approval regulations have further restricted competition and led to increased prices.

The panelists addressed how, in practice, the high price of insulin has had devastating consequences. Dr. Lipska described how its price tag in the United States — sometimes hundreds of dollars a vial — has forced many patients to go without insulin. She said that as many as 25 percent of patients have had to ration their insulin, which can lead to severe medical complications, coma, or death.

The conversation then turned to solutions for access to insulin, including state insulin price capping laws, policies to promote biosimilar competition, and government manufacturing. Though some seemed promising, many would have a limited impact for many patients or significant barriers to implementation. Ultimately, the panelists concluded that government pricing regulation likely would be needed to lower the price of insulin in a meaningful way for most patients.

Beran succinctly summarized the purpose of the event: “One hundred years ago, a lifesaving medicine was discovered. Yet, people in the richest country in the world are still dying because they can’t afford that.” The panelists hoped that this event could inform future conversations among policymakers on access to insulin and drug pricing more broadly.